scholarly journals Gross Hematuria as a Presenting Feature of Posterior Urethral Valves in a Neonate with Normal Antenatal Sonograms

Medicines ◽  
2020 ◽  
Vol 7 (1) ◽  
pp. 5
Author(s):  
Ratna Acharya ◽  
Romano DeMarco ◽  
Kiran Upadhyay
Keyword(s):  
Obstructive Uropathy ◽  
Kidney Injury ◽  
Posterior Urethral Valves ◽  
Gross Hematuria ◽  
Initial Manifestation ◽  
Fetal Hydronephrosis ◽  
Urethral Valves ◽  
Study Results ◽  
Male Neonate ◽  
High Index Of Suspicion

Background: Posterior urethral valves (PUVs) are usually suspected during antenatal sonograms or by postnatal evidence of bilateral hydronephrosis with enlarged bladder. Gross hematuria as an initial manifestation of PUV with a history of normal antenatal sonogram is very rare. Methods: This is a retrospective chart study. Results: We describe a nine-day-old male neonate who presented with gross hematuria and was later found to have a urinary tract infection (UTI) and severe acute kidney injury (AKI). The mother apparently had normal antenatal sonograms with no evidence of fetal hydronephrosis. The child did not have postnatal renal bladder sonogram done until gross hematuria occurred at Day 9 of life. Sonogram showed bilateral severe hydronephrosis and hydroureter with enlarged bladder. The patient underwent ablation of the PUVs after initial bladder decompression with indwelling urethral catheterization. His AKI resolved after prompt treatment of UTI and PUV ablation. Conclusions: This report emphasizes the importance of a high index of suspicion for obstructive uropathy in a newborn with gross hematuria irrespective of prenatal sonogram findings.

Prognostic Features in Infants With Obstructive Uropathy Due to Posterior Urethral Valves

1985 ◽  
Vol 133 (2) ◽  
pp. 240-242 ◽  
Author(s):  
Barry L. Warshaw ◽  
Leonard C. Hymes ◽  
Timothy S. Trulock ◽  
John R. Woodard
Keyword(s):  
Obstructive Uropathy ◽  
Posterior Urethral Valves ◽  
Urethral Valves ◽  
Prognostic Features

Obstructive Uropathies

2019 ◽  
pp. 175-182
Author(s):  
Priya Deshpande ◽  
Shuchita Sharma
Keyword(s):  
Urinary Tract ◽  
Imaging Modality ◽  
Obstructive Uropathy ◽  
Kidney Injury ◽  
Flank Pain ◽  
Permanent Damage ◽  
Extrinsic Compression ◽  
High Index Of Suspicion ◽  
Prompt Diagnosis

Obstructive Uropathy remains an important cause of acute kidney injury. The etiology of obstructive uropathy can be very variable ranging from extrinsic compression of the urinary tract by tumors or surrounding structures to intraluminal obstruction by crystals and stones. Patients with obstructive uropathy manifest symptoms based on the area of obstruction within the urinary tract. Flank pain, hematuria, and suprapubic discomfort are some of the associated symptoms. The diagnosis of obstructive uropathy requires a high index of suspicion and, depending on its nature, can be confirmed clinically and/or with an imaging modality. Prompt diagnosis and treatment with effective relief of obstruction is important in preventing long-term and permanent damage to the kidneys.

scholarly journals Posterior Urethral Valves

2009 ◽  
Vol 9 ◽  
pp. 1119-1126 ◽  
Author(s):  
Steve J. Hodges ◽  
Bhavin Patel ◽  
Gordon McLorie ◽  
Anthony Atala
Keyword(s):  
Early Diagnosis ◽  
Urinary Tract Obstruction ◽  
Obstructive Uropathy ◽  
Posterior Urethral Valves ◽  
Urethral Obstruction ◽  
Urethral Valves ◽  
Lower Urinary Tract Obstruction ◽  
Posterior Urethra ◽  
Prenatal Hydronephrosis ◽  
Long Term Prognosis

The most common cause of lower urinary tract obstruction in male infants is posterior urethral valves. Although the incidence has remained stable, the neonatal mortality for this disorder has improved due to early diagnosis and intensive neonatal care, thanks in part to the widespread use of prenatal ultrasound evaluations. In fact, the most common reason for the diagnosis of posterior urethral valves presently is the evaluation of infants for prenatal hydronephrosis. Since these children are often diagnosed early, the urethral obstruction can be alleviated rapidly through catheter insertion and eventual surgery, and their metabolic derangements can be normalized without delay, avoiding preventable infant mortality. Of the children that survive, however, early diagnosis has not had much effect on their long-term prognosis, as 30% still develop renal insufficiency before adolescence. A better understanding of the exact cause of the congenital obstruction of the male posterior urethra, prevention of postnatal bladder and renal injury, and the development of safe methods to treat urethral obstruction prenatally (and thereby avoiding the bladder and renal damage due to obstructive uropathy) are the goals for the care of children with posterior urethral valves[1].

Amniotic Fluid α-Fetoprotein in Fetal Obstructive Uropathy

PEDIATRICS ◽  
1980 ◽  
Vol 66 (4) ◽  
pp. 537-539
Author(s):  
William M. Dean ◽  
Emory J. Bourdeau
Keyword(s):  
Amniotic Fluid ◽  
Congenital Anomalies ◽  
Obstructive Uropathy ◽  
In Utero ◽  
Posterior Urethral Valves ◽  
Urinary Obstruction ◽  
Type I ◽  
Urethral Valves

Amniotic fluid α-fetoprotein has been associated with various congenital anomalies. A diagnosis in utero of urinary obstruction associated with elevated α-fetoprotein is reported. Subsequent fulguration of type I posterior urethral valves was done. A possible mechanism for elevated α-fetoprotein with obstructive uropathy in utero is discussed.

Neonatal gross hematuria as a presenting sign of posterior urethral valves

Urology ◽  
1992 ◽  
Vol 40 (3) ◽  
pp. 267-269 ◽  
Author(s):  
David A. Diamond ◽  
Carla Ford
Keyword(s):  
Posterior Urethral Valves ◽  
Gross Hematuria ◽  
Urethral Valves

scholarly journals Neonate with urinary ascites but no hydronephrosis: unusual presentation of posterior urethral valves

2018 ◽  
pp. bcr-2018-225053
Author(s):  
Elisabetta Prat ◽  
Patricia Seo-Mayer ◽  
Swati Agarwal
Keyword(s):  
Urinary Tract Obstruction ◽  
Obstructive Uropathy ◽  
Male Infant ◽  
Posterior Urethral Valves ◽  
Unusual Presentation ◽  
Voiding Cystourethrogram ◽  
Urinary Ascites ◽  
Urethral Valves ◽  
Bladder Distention ◽  
Distended Bladder

Posterior urethral valves (PUV) are an important cause of paediatric obstructive uropathy. PUV are usually diagnosed by prenatal ultrasonography (US) revealing hydronephrosis and bladder distention. We describe a 17-day-old male infant with abdominal distention who had no hydronephrosis on prenatal US. Laboratory investigations showed serum creatinine of 12 mg/dL, hyperkalaemia and metabolic acidosis. Abdominal US showed large amount of ascites, normal-sized kidneys without hydronephrosis and incompletely distended bladder. Paracentesis revealed clear, yellow ascitic fluid with creatinine level of 27 mg/dL compatible with urinary ascites. Voiding cystourethrogram (VCUG) demonstrated PUV with a dilated posterior urethra, grade 5 right vesicoureteral reflux and a ruptured kidney fornix with peritoneal extravasation of contrast. Foley decompression resulted in normalisation of creatinine within 72 hours. Transurethral resection of PUV was performed, and a repeat VCUG showed recovery of forniceal rupture. This case illustrates an unusual presentation of a potentially life-threatening but treatable cause of urinary tract obstruction.

scholarly journals Congenital Bladder Diverticulum in a Neonate Simulating Posterior Urethral Valves

2018 ◽  
Vol 7 (4) ◽  
pp. 49
Author(s):  
Tapasya Pandita ◽  
Nitin James Peters ◽  
Ram Samujh
Keyword(s):  
Urinary Tract ◽  
Urinary Retention ◽  
Urinary Tract Infections ◽  
Posterior Urethral Valves ◽  
High Index ◽  
Bladder Diverticulum ◽  
Urethral Valves ◽  
Primary Bladder ◽  
Tract Infections ◽  
High Index Of Suspicion

Primary bladder diverticulae are rare anomalies of the bladder. They usually present with recurrent urinary tract infections and dysuria. We present a case of retrovesical diverticulum, which presented with urinary retention behaved like a case of posterior urethral valves. A high index of suspicion and a well performed micutrating cystourethrogram helps in clinching the diagnosis. Excision of these diverticulae with or without ureteric reimplant is curative in most cases.

Fetal Urinoma Due to Circulatory Disorders in an Umbilical Artery: Case Report

2021 ◽  
pp. 109352662110027
Author(s):  
Daria Kozlova ◽  
Yinon Gilboa ◽  
Chen Sade-Zalts ◽  
Yuval Gielchinsky ◽  
Shimon Shteingart ◽  
...  
Keyword(s):  
Umbilical Artery ◽  
Ureteropelvic Junction Obstruction ◽  
Obstructive Uropathy ◽  
Bladder Wall ◽  
Vascular Supply ◽  
Posterior Urethral Valves ◽  
Ischemic Necrosis ◽  
Unique Case ◽  
Urethral Valves ◽  
Circulatory Disorders

Fetal urinoma is defined as an encapsulated accumulation of extravasated urine within the perirenal space or retroperitoneum. It is an uncommon finding in prenatal practice, and the vast majority of known cases are strongly associated with the existence of a urinary obstruction, such as posterior urethral valves, ureteropelvic junction obstruction, or ureterocele. We report a unique case of prenatally detected fetal bladder urinoma that occurred in the absence of an apparent obstructive uropathy, but was associated with extensive ischemic necrosis and calcifications of adjacent bladder wall, coexistent with signs of vascular supply decompensation.

scholarly journals Rare Associations with Posterior Urethral Valves

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Ahmed Osama Mohamed ◽  
Bala Eradi ◽  
Anthony Owen ◽  
Ashok Rajimwale
Keyword(s):  
Bladder Outlet Obstruction ◽  
Twin Pregnancy ◽  
Outlet Obstruction ◽  
Case Series ◽  
Anorectal Malformations ◽  
Posterior Urethral Valves ◽  
Common Cause ◽  
Urethral Valves ◽  
High Index Of Suspicion ◽  
Gastrointestinal Abnormalities

Posterior urethral valves are a common cause of congenital bladder outlet obstruction. Known associations include cardiac malformations and gastrointestinal abnormalities. In this case series, we report on two cases of PUV associated with anorectal malformations along with a case of PUV in monochorionic diamniotic twins. We explore the difficulty in achieving a diagnosis and the final management. The association of posterior urethral valves in a patient with anorectal malformation should be suspected in case of associated oligohydramnios or oliguria postnatally. There should be a high index of suspicion in twin pregnancy even if only one of the twins is suspected of bladder outlet obstruction.

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